META-analysis On The Risk Factor Of Heart Block After Transcatheter Closure Of Perimembranous Ventricular Septal Defect

Objective:Heart block is the common complications after cardiac catheterizations of Perimembranous Ventricular Septal Defect(PMVSD),that can cause negative prognosis.To analyze the the risk factor of heart block after transcatheter closure of PMVSD and to provide evidence for prevention and recognition on heart block after transcatheter closure of PMVSD by meta-analysis.Methods:We searched the PubMed?Cochrane library?Embase?Wanfang?Cnki from the start time of the data bases to June 2019,filter?extracted data and assessed the methodological quality.Meta-analysis was carried out by Review Manager(Version 5.3)provided by Cochrane Collaboration.For controversial result,the quality of evidence is evaluated using Grades of Recommendations Assessment,Development and Evaluation system.Result:A total of 7 observational studies,include 3 case-control studies and 4 cohort studies.Diameter of PMVSD > 8mm(RR= 1.93,95%CI:1.08-3.44,P=0.03)?Size of Occluder>10mm(RR=2.00,95%CI:1.04-3.81,P= 0.04)are statistically significant.Distance from the upper edge of the defect to right coronary valve of the aorta<3mm(RR=1.57,95%CI:0.50-4.95,P=0.44)? asymmetrical occluder(RR=1.35,95%CI:0.68-2.66,P=0.39)?aneurysm-like perimembranous ventricular septal defect(RR=1.10,95%CI:0.80-1.52,P=0.56)are not statistically significant.Diameter of occluder(WMD=1.20,95%CI ?0.74-1.66,P <0.00001)are statistically significant.Diameter of PMVSD(WMD=0.35,95%CI:-0.42-1.12,P=0.38)?the upper edge of the defect to right coronary valve of the aorta(WMD=0.17,95%CI:-0.41-0.76,P=0.57)are not statistically significant.Conclusion:The Diameter of PMVSD and diameter of the occluder is the risk factor of heart block after Transcatheter Closure of PMVSD.Distance from the upper edge of the defect to right coronary valve of the aorta ? Asymmetric occluder and Aneurysm-like perimembranous ventricular septal defect is not the risk factor of heart block after transcatheter closure of PMVSD.